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Echocardiogram Basics Iowa ACC CV Team 12-5-2020 1.pdf
- 1. ECHOCARDIOGRAM BASICS Iowa Chapter of the ACC Cardiovascular Team Conference 12-5-2020 Stephanie Ellingson, MS, RDMS, RDCS, RVT Director, Diagnostic Medical Sonography Education Carver College of Medicine – Radiation Sciences
- 2. Disclosures: I have no disclosures
- 3. Welcome to the virtual conference… Thanks to the Iowa Chapter of the ACC CV Team
- 4. Objectives Upon completion of this presentation the learner will: 1. Understand the different views in transthoracic echocardiograms 2. Identify basic structures of the heart on transthoracic echocardiograms
- 5. Outline I. Basic ultrasound imaging principles II. Sonographic terminology III. Windows, scan planes, color and spectral Doppler A. Parasternal window 1. Long axis – standard, RV inflow, RVOT 2. Short axis – base, mitral valve, mid LV B. Apical window 1. 4 chamber 2. 5 chamber 3. 2 chamber 4. 3 chamber (long axis) C. Subcostal 1. 4 chamber 2. IVC 3. Aorta D. Suprasternal notch 1. Aortic arch 2. Descending aorta 3. SVC IV. Summary
- 6. Basic Ultrasound Imaging Principles Pulse-echo technique • US sent into body, reflects off structures and returns to the transducer • Instrument/computer processes the reflections into an image • Pulsing provides time/depth information Animation courtesy of Dr. Dan Russell, Kettering University
- 7. Basic Ultrasound Imaging Principles Beam is moved through the body in a sweeping action producing real-time Displayed reflections Intensities based on the intensity of the returning echo Locations corresponding to the direction of the beam sent out Depth based on return time of reflections Scan Lines Animation courtesy of Dr. Dan Russell, Kettering University
- 8. Basic Ultrasound Imaging Principles Transducers • Low Frequency has poor spatial resolution • Small footprint • Phased array • Vector (Siemens) Frame Rate • High (>40 Hz) for temporal resolution • Narrow sector • Color is always a lower frame rate
- 9. Basic Ultrasound Imaging Principles B color/Colorize • Eye may be more sensitive to color than black/white • Colorization can help bring out subtle aspects of the image • Peak velocities • Thrombus • Walls/endocardium • Colorization is used to help demonstrate depth in 3D imaging
- 10. Basic Ultrasound Imaging Principles Doppler Effect • Change in frequency when there is motion between the source and receiver • Medical ultrasound it’s motion of a reflector • Toward is above the baseline and red • Away is below the baseline and blue Bushong 1991
- 11. Basic Ultrasound Imaging Principles Doppler Angle • Parallel to flow is best • Perpendicular to flow has limited flow detection • Angle of more than 20 degrees will result in slower calculated velocity
- 12. Sonographic Terminology • Echogenic – having echoes, white • Anechoic/Sonolucent – without echoes, black • Hyperechoic – having more echoes when compared to adjacent structure • Hypoechoic – having less echoes when compared to adjacent structure • Isoechoic – having the same echogenicity as adjacent structure Hypoechoic vs Hyperechoic Echogenic Anechoic Isoechoic
- 13. 2D Windows and Scan Planes Windows – improve the angle to anatomy and flow 1. Left parasternal 2. Apical 3. Subcostal 4. Suprasternal notch Hagen-Ansert, 2018 (1) (2) (3) (4)
- 14. 2D Windows and Scan Planes Scan Planes – must see all walls in two planes, 17 segments • Long axis • Short axis • 4 chamber • Variations of these Hagen-Ansert, 2018 Long Short 4 chamber
- 15. 2D Windows and Scan Planes Left Parasternal Long Axis Left Atrium Mitral Valve Left Ventricle Ascending Aorta Posterior Wall Papillary Muscles Apex Septum Aortic Valve Coronary sinus
- 16. 2D Windows and Scan Planes Left Parasternal – Long Axis • Pleural effusion • Pericardial effusion
- 17. Doppler Imaging Left Parasternal – Long Axis • Long axis zoom for valves – Mitral regurgitation – Aortic insufficiency Normal Aortic Insufficiency
- 18. 2D Windows and Scan Planes Left Parasternal • Right ventricular (RV) inflow for tricuspid valve (TV) • Right ventricular outflow tract (RVOT) for pulmonic valve Hagen-Ansert, 2018 https://thoracickey.com/right-heart/
- 19. 2D Windows and Scan Planes Left Parasternal Short Axis • Base • Mitral valve • Mid ventricle Hagen-Ansert, 2018
- 20. 2D Windows and Scan Planes Left Parasternal - Short Axis • Aortic stenosis • Atrial septal defect This patient also has a pacemaker in, see RA through TV into RV
- 21. 2D Windows and Scan Planes Apical 4 chamber
- 22. 2D Windows and Scan Planes Apical - 4 chamber • Poor ejection fraction with apical thrombus • Dilated right atrium – Pacer wire with thrombus
- 23. 2D Windows and Scan Planes Apical – 4 chamber • Mitral valve • Tricuspid valve
- 24. 2D Windows and Scan Planes Apical – 4 chamber • Tricuspid regurgitation – Increased RV pressure – Pressure Gradient = 4(Vmax)2 – Pulmonary hypertension TR Vel(max) approx. 3.5 m/s RV to RA PG = 4(3.5m/s)2 = 49 mmHg Est RV pressure >= 52 mmHg dependent on RA pressure Pitfall – varying velocities, need multiple measurements
- 25. 2D Windows and Scan Planes Apical • 5 chamber - Left ventricular outflow tract (LVOT) • 3 chamber (long axis) • 2 chamber Hagen-Ansert, 2018
- 26. 2D Windows and Scan Planes Apical – 5 chamber • Stroke volume
- 27. 2D Windows and Scan Planes Apical – 3 chamber • Aortic stenosis • Aortic insufficiency Vmax= 4.5 m/s Est. peak PG 81 mmHg
- 28. 2D Windows and Scan Planes Subcostal • 4 chamber • IVC with sniff • Abdominal aorta Hagen-Ansert, 2018 Anderson, B, 2007
- 29. 2D Windows and Scan Planes Subcostal – IVC • IVC normal collapse • IVC plethora Increased central venous pressure
- 30. 2D Windows and Scan Planes Suprasternal Notch • Long axis aortic arch • Long axis descending thoracic aorta • Short axis aortic arch Hagen-Ansert, 2018
- 31. 2D Windows and Scan Planes Suprasternal Notch • Normal flow in descending thoracic aorta
- 32. 2D Windows and Scan Planes Suprasternal Notch • Coarctation Vmax = 5 m/s Estimated peak PG 100 mmHg
- 33. This and That… Agitated Saline (bubble study) • ASD • PFO • Transpulmonic shunt (pulmonary arteriovenous fistula) • Persistent left superior vena cava Negative Positive – Secundum ASD
- 34. This and That… Image enhancing agent (contrast) • Endocardial delineation • Ejection fraction • Wall motion abnormalities • Thrombus • Non-compaction
- 35. Summary 1. Understand the different views in transthoracic echocardiograms A. Left parasternal window • Long axis • Short axis B. Apical window • 4 chamber • 5 chamber • 3 chamber • 2 chamber C. Subcostal • 4 chamber • IVC long axis D. Suprasternal notch • Aortic arch long axis • Descending aorta • Aortic arch short axis
- 36. Summary 2. Identify basic structures of the heart on transthoracic echocardiograms A. Pericardium B. Chambers C. Valves D. Aorta and Pulmonary arteries E. Flow characteristics References 1. Hagen-Answer S. Textbook of Diagnostic Sonography, 8th Edition. Elsevier, 2018. 2. Anderson B. Echocardiography: The Normal Examination and Echocardiographic Measurements, 2007.